What’s the easiest way to explain the difference between Medicare and Medicaid?
Medicare is a federal program provided through the social security office. When you pay into social security, you pay a Medicare tax. Medicare does not pay for long-term nursing home care. Medicaid is the only provider for nursing home care. Medicaid is a state program.
I know nothing about Medicaid and it’s time to start looking at options for my parent(s). Where do I start?
The first place to start making plans regarding Medicaid and long-term nursing home care is at the Medicaid site itself, here. Once you’ve familiarized yourself with the Medicaid basics, the Medicaid monthly income limits are displayed here. The resource limit for Medicaid varies depending on whether a person is married, single or just one spouse is going into long term care.
How do I determine the exact resource-eligibility amount for my parents?
The state Medicaid website linked above is a great resource to figure out the standard amount, as well as the maintenance amount allowed for the spouse remaining at home. Information regarding the resource limit and spousal impoverishment standards is on the Medicaid website under “long-term care.”
Is it true I have to deplete my parent(s) of any assets for him or her to qualify?
No, that’s not true. An individual can have up to $2,000 in assets in addition to a home and car. The total resource amount for a couple in a nursing home is $3,000.
What if one of my parents is ready for long-term care and one isn’t?
The spousal impoverishment program is a good program for a husband and wife if one is ready to enter long-term nursing home care and the other isn’t. The two of them together are allowed $126,420 in assets, and the one at home may be eligible to continue to receive the other’s social security check if their total income falls beneath maximum monthly maintenance need allowance.
What if we have an immediate need for long-term care in a nursing home and my parent has not yet qualified for Medicaid?
If an individual needs to enter a nursing home before completing the process of qualifying for Medicaid, he or she is limited to $2,000 in assets. That total includes bank account, investments and anything else the patient might own, with two major exceptions — every individual is entitled to a home and a car, which are not included in the resource limit. The total resource amount for a couple in a nursing home is $3,000. However, a person may not own a separate piece of property outside of their personal home. If a person owns another property or properties and wants to qualify for Medicaid, he or she will need to sell the additional properties and use available resources to private pay for nursing home care until the resources are depleted within the $2,000 limit.
Note: A person may own a house AND the property next door. That scenario is considered “a continuation of an estate,” not a separate piece of property.
Can one spouse transfer assets to another or to one’s children?
Yes, but Medicaid has a five-year look-back period. If a person gives or undersells a resource to children or anyone else, the person attempting to qualify for Medicaid will be responsible for the market value or said resources divested within the five-year look-back period.
Is it possible to be admitted to a nursing home before Medicaid approval?
Yes, that is a condition called Medicaid pending.
The patient interview requires the patient and family be honest and forthright about the financial situation. Incorrect or missing information only results in eventual penalties or Medicaid disqualification. Even during a thorough interview, the family sometimes withholds information and is denied Medicaid after admittance to the nursing home. In those cases, the person may reapply when their financial situation has changed.
Is there a difference in the level of care people receive if they’re on Medicaid and private pay?
No, it’s exactly the same. Most of the time, staff doesn’t know payment source.
NOTE: Information contained herein may contain general explanations of laws. It should not be considered as legal advice. Please seek counsel from an attorney regarding legal planning.
The above questions were answered and information provided by Camelot staff members, Paula Richardson and Barbara Sonia.
About Paula Richardson
Paula Richardson is the regional administrator for Camelot Senior Living. With more than forty years’ experience in healthcare management and administration, her passion is serving the elderly and making certain they are loved and cared for according to their needs. Richardson earned her B.A. from McNeese State University. From her first days as a licensed nursing home administrator, she has been active in long term care consulting and management specializing in helping turn around problem buildings and quality issues. Richardson lives by the verse Philippians 2:3: "Do nothing out of selfish ambition or vain conceit, but in humility consider others better than yourselves."
About Barbara Sonia
Barbara Sonia is the accounts receivable specialist for Camelot Senior Living. She has ten years of experience working with the state in certifying Medicaid. Over the past five years, Sonia has brought her knowledge to helping people determine payment options for nursing homes. She is skilled in financial advising for families of potential residents. Sonia recommends preparing in advance for retirement and the possibility of entering a nursing home to minimize financial burden when that time comes.